Characteristics of timed barium esophagogram in newly diagnosed idiopathic achalasia: clinical and manometric correlates

Andersson, Mats; Kostic, Srdjan; Ruth, Magnus; Lönroth, Hans; Kjellin, Ann; Hellström, Mikael; Lundell, Lars

doi:10.1080/02841850601026393

Cited by 10 publications

(9 citation statements)

References 17 publications

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“…Review of prior literature regarding correlation of symptoms with TBE or HRM findings shows inconsistent results . Andersson and colleagues reported an inverse correlation between TBE width and postprandial chest pain ( r = −0.44) .…”

Section: Discussionmentioning

confidence: 99%

“…8,10 TBE, HRM, and symptoms Review of prior literature regarding correlation of symptoms with TBE or HRM findings shows inconsistent results. 3,8,9,[13][14][15][16][17][18][19] Andersson and colleagues reported an inverse correlation between TBE width and postprandial chest pain (r = −0.44). 13 In a study by Yaghoobi and colleagues, active and passive regurgitation showed significant correlation with LES pressure.…”

Section: Principal Findingsmentioning

confidence: 99%

“…3,8,9,[13][14][15][16][17][18][19] Andersson and colleagues reported an inverse correlation between TBE width and postprandial chest pain (r = −0.44). 13 In a study by Yaghoobi and colleagues, active and passive regurgitation showed significant correlation with LES pressure. 15 However, no significant association between symptoms, and HRM or TBE variables has been observed in other studies.…”

Section: Principal Findingsmentioning

confidence: 99%

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Timed barium esophagram in achalasia types

Zanoni¹,

Rice²,

López³

et al. 2014

Dis Esophagus

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Relationships of timed barium esophagram (TBE) findings to achalasia types defined by high-resolution manometry (HRM) have not been elucidated. Therefore, we correlated preoperative TBE and HRM measurements in achalasia types and related these to patient symptoms and prior treatments. From 2006 to 2013, 248 achalasia patients underwent TBE and HRM before Heller myotomy. TBE height and width were recorded at 1 and 5 minutes; HRM measured lower esophageal sphincter mean basal pressure, integrated relaxation pressure (IRP), and mean esophageal body contraction amplitude. Achalasia was classified into types I (25%), II (65%), and III (9.7%). TBE height at 5 minutes was higher for I (median 8 cm; interquartile range 6-12) and II (8 cm; 8-11) than for III (1 cm; 0-7). TBE width at 5 minutes was widest (3 cm; 2-4), narrower in II (2 cm; 2-3), and narrowest in I (1 cm; 0-2), P < 0.001. Volume remaining at 1 and 5 minutes was lower in III (1 m(2) ; 0-16) than I (42 m(2) ; 17-106) and II (39 m(2) ; 15-60), highlighting poorer emptying of I and II. Increasing TBE width correlated with deteriorating morphology and function from III to II to I. Symptoms poorly correlated with TBE and HRM. Prior treatment was associated with less regurgitation, faster emptying, and lower IRP. Although TBE and HRM are correlated in many respects, the wide range of their measurements observed in this study reveals a spectrum of morphology and dysfunction in achalasia that is best characterized by the combination of these studies.

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Section: Discussionmentioning

confidence: 99%

Section: Principal Findingsmentioning

confidence: 99%

Section: Principal Findingsmentioning

confidence: 99%

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Timed barium esophagram in achalasia types

Zanoni¹,

Rice²,

López³

et al. 2014

Dis Esophagus

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“…Esophageal emptying was assessed by the height of the barium column at the 1‐minute and 5‐minute time‐points, respectively 10 . The estimated volume of the barium column was also included as a measure of esophageal emptying as it has been shown that this variable correlates with the manometric tone of the LES in patients with idiopathic achalasia 14 . The volume of barium in the esophagus was calculated according to the formula: (mean radius) 2 × 3.14 × height (after correction for magnification by dividing the measurements with a factor of 1.35).…”

Section: Methodsmentioning

confidence: 99%

Evaluation of the response to treatment in patients with idiopathic achalasia by the timed barium esophagogram: results from a randomized clinical trial

Andersson

Lundell

Kostic

et al. 2009

Diseases of the Esophagus

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To choose which treatment would be most effective for the individual patient with newly diagnosed achalasia is difficult for the tending physician. A diagnostic tool that would allow prediction of the symptomatic and functional response after treatment for achalasia is therefore needed. The timed barium esophagogram (TBE) is a method that allows objective assessment of esophageal emptying, but the value of TBE in the clinical management of achalasia remains to be clarified. The aim of this study was first, to assess the ability of TBE to predict symptoms and treatment failure during post-treatment follow-up. Second, to determine whether esophageal emptying as assessed by TBE differs after treatment with pneumatic dilatation or laparoscopic myotomy. Fifty-one patients with newly diagnosed achalasia were prospectively randomized to pneumatic dilatation (n = 26) or laparoscopic myotomy (n = 25). Evaluation with TBE was performed before (n = 46) and after treatment (n = 43). The median interval between treatment and post-treatment TBE was 6 months, and the median follow-up time after the post-treatment TBE was 18 months. Following therapeutic intervention, TBE parameters did not differ significantly between treatment groups. However, significant correlations were found between the height of the barium column at 1 min and the symptom scores at the end of follow up for 'dysphagia for liquids' (P < 0.05, rho = 0.47), 'chest pain' (P < 0.05, rho = 0.42), and the 'Watson dysphagia score' (P < 0.05, rho = 0.46). Patients with less than 50% improvement in this TBE-parameter (height at 1 min) post-treatment had a 40% risk of treatment failure during follow-up. In summary, pneumatic balloon dilatation and laparoscopic myotomy similarly affected esophageal function as assessed by TBE-emptying. Lack of improvement in barium-column height post-treatment was associated with an increased risk of treatment failure which should motivate close surveillance in order to detect symptomatic recurrence at an early stage.

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“…With respect to barium contrast studies, Andersson et al. demonstrated that delayed emptying correlates with increased LES pressures, thereby demonstrating a positive correlation between radiographic and manometric findings in achalasia patients 13 . Furthermore, the authors were able to demonstrate a statistically significant inverse relationship between the duration of symptoms and emptying capacity of the esophagus.…”

Section: Discussionmentioning

confidence: 95%

Clinical predictors of achalasia

Ferri

Cools-Lartigue

Cao

et al. 2010

Diseases of the Esophagus

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Limited access to esophageal manometry (EM) may delay identification and treatment of patients with achalasia. In order to assess predictors to fast-track patients for manometric confirmation of achalasia, we compared the clinical, radiographic, and endoscopic characteristics of achalasia patients to patients with functional dysphagia without manometric features of achalasia (controls). Patients referred for esophageal manometry to assess functional dysphagia prospectively identified over a 12-month period were asked to participate in this study. The Achalasia Symptom Questionnaire (ASQ), a structured 11-question survey (score: 0-best, 67-worst), was completed by all consenting patients. ASQ scores, esophago-gastro-duodenoscopy and upper gastro-intestinal (UGI) contrast study findings were compared between patents with subsequently confirmed achalasia and those in whom achalasia was excluded by EM. Univariate logistic regression identified predictors that were tested by multivariate logistic regression to generate the model. Of the 803 EM performed over this 12-month period, 95 patients were referred specifically to assess functional dysphagia. Of these, 50 were confirmed to have achalasia, and 45 had dysphagia without manometric evidence for achalasia and hence comprised the control group. ASQ scores were higher in achalasia patients (37+/-13 versus 23+/-10). Endoscopy and/or contrast esophagogram reports were available in 92% achalasia patients and 80% controls. Significant predictors for achalasia identified on univariate logistic regression included ASQ score, abnormal findings on endoscopy, and contrast UGI study. Using multivariate logistic regression, we were able to accurately predict the probability of achalasia to be P where P=ey/(1+ey) and y=5.6+(0.089xASQ)+(2.088xEGD)+(3.083xUGI), e=exponential constant 2.7182, esophagogastroduodenoscopy (EGD) and UGI=0 if normal and 1 if abnormal. Dropping the predictor ASQ, the formula changes to y=-2.7+(1.987xEGD)+(2.861xUGI). Using only noninvasive investigations (i.e. eliminating EGD), the formula changes to y=-4.9653+(0.0951xASQ)+(3.4312xUGI). The probability of achalasia can be calculated in patients with functional dysphagia based on clinical, endoscopic, and radiographic findings allowing for a prioritization of EM studies.

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Characteristics of timed barium esophagogram in newly diagnosed idiopathic achalasia: clinical and manometric correlates

Cited by 10 publications

References 17 publications

Timed barium esophagram in achalasia types

Timed barium esophagram in achalasia types

Evaluation of the response to treatment in patients with idiopathic achalasia by the timed barium esophagogram: results from a randomized clinical trial

Clinical predictors of achalasia

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